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1215563283

NPI Code Detail

MEDICARE: CORY KISHI HIRO MAYFIELD MD

MEDICARE: CORY KISHI HIRO MAYFIELD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	036.178366	IL
2	207X00000X	Orthopaedic Surgery Physician	01099134A	IN
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	036.178366	IL
4	207X00000X	Orthopaedic Surgery Physician	A179921	CA
5	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	01099134A	IN

General Provider Information

NPI Number	:	1215563283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY KISHI HIRO MAYFIELD MD

Provider Business Mailing Address
First Line	:	PO BOX 735263
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5263
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 W HARRISON ST STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4861
Country	:	US
Telephone Number	:	877-632-6637
Fax Number	:	708-409-5179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	05/08/2026

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1063091932 — DR. ROBERT RAYMOND HALL III MD
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1548848468 — CONNOR GUERNICA HOGE MD
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1611 W HARRISON ST STE 400
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60612-4861

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1639604994 — DR. THOMAS JAMES KELSEY M.D.
Practice Location Address:

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1255951224 — MATTHEW THOMAS KINGERY MD
Practice Location Address:

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60612-4861

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1649849985 — HAYDEN DOUGLAS MCBRIDE MD
Practice Location Address:

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60612-4861

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Practice Fax: 708-409-5179

Directions to “ CORY KISHI HIRO MAYFIELD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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